On Call : Dr. Daisy Dashwood writes........

Where do all the butterflies go? We've had an epidemic of them, fluttering hither and thither throughout the hospital. Everywhere you look there's a stray Cabbage White or Tortoiseshell weaving its way in and out of the kardexes. And it's not confined to the hospital, either. The Doctor's Residence is also infested with our fluttering friends. I've lost count of the number I've liberated from the windowsill to the point where Gordon suggested I replace my tourniquet with a butterfly net and let the porters pose as Dracula instead.

Speaking of Gordon, I've changed SHO this week. There doesn't seemt o be that much continuity at the Royal Scottish Hospital and we're now onto our 2nd SHO in a month. This week I had the joy of Edward, an extremely properly spoken chap from the Home Counties. Together, Edward and I battled our way through the piles of alcoholics and social attenders who seemed to lie in wait for our receiving night, descending en masse to bed block the wards.

My on call this week was pretty hectic. I'd been called to bleed a lady with collapsible veins which puffed up ever so nicely when you wrapped a tourniquet around them and then evaporated once punctured. I'd just gained access when the bleep crackled into life and hissed "Cardiac arrest, CT, X-Ray Department".

I panicked for 2 reasons. 1) I would have to reverse from her one good vein and 2) I had a vague memory of someone saying we might want to make a note of where CT was in that first week, in case someone went into anaphylaxis down there. Unfortunately, I couldn't expand upon this memory, chiefly as I had not yet made contact with the CT room. Aha! X-ray! Shoving my sharps at a bemused cleaner, I took off at full pelt. Unfortunately, I forgot that Daisy can't actually run, especially in heels, with a stethoscope flapping gaily around my head and various assorted bleeps banging off my torso. Down the stairs I clattered. Phew, deserted. Only a few people in the corridor, just the Outpatient Department to negotiate. As I flew around the corner, I beheld a huge crowd of people who, turning to see what the clattering was all about, simulataneously parted as if I were Moses, as I thundered through, bounced off the X-Ray door and tried to casually run through the next door as if nothing had happened.

"Go back to the ward," said Amos, the Registrar. "There's enough people in here. I hear there's a lady upstairs who's very tricky to bleed..." Grrrr.

"I saw you today!" squealed Mary, one of my fellow House Officers. "We were all having coffee in the WRVS whan you came thumping by!"

"That's nice to know," I said weakly.

"You cleaning Ward 9 today?" I heard a Domestic Assistant enquire of one of her larger counterparts.

"No; why?" replied the lady in question.

"'Cos it sounded like a herd of baby elephants coming down the stairs this morning." I crept silently and unobtrusively away, on tiptoe.

"Lost the bloods folder again, did you?" enquired Janey, an SHO, later in the afternoon.

"No!" I lied. "Why?"

"Me and John saw you crashing through the relatives this morning. It was like ten pin bowling! Kept us all amused for hours!"

Damn! John's the cute House Officer and one I would rather saw me smoothly flick in two venflons simultaneously rather than scattering civilians left, right and centre.

"Er, how much did you see?" I asked casually.

"Well, your pants, for one," she said, ticking off on her fingers.

"My pants?!"

"Oh yeah, your skirt was falling down. And you know that episode where Rachel wants to go jogging in Friends?"

"Er, yes?"

"Think Phoebe. And the moment you ran into the door. I mean, we'd seen it all before but there was this one old lady who had to be helped to a seat, and I think that the Tena Lady might have also been called into action at one point. Pity you had to choose the incontinence clinic to barge through."

"Did, er, John see?" I asked desperately.

"He saw EVERYTHING!" she emphasised happily.

"Even my pants?" I said in a small voice.

"Especially your pants!" she said happily. "Why; d'you fancy him?"

"No!" I lied indignantly.

When we do on call, we tend to cover the medical side of A and E. Which is why I was cursing my luck at being on on a Friday night. I'd wandered into Resus to use the X-Ray box to help elucidate some more on an elderly gentleman with a 2 day history of shortness of breath and was squinting into the light in what I hoped looked like a competent manner. Out of the corner of my eye, I saw a flurry of movement and a nurse burst through the curtain.

"Oh Doctor, Thank God you're here!" she exclaimed breathlessly.

Bugger.

I thought rapidly, trying to think of a way out. But there was no way. I couldn't deny it, I was the doctor.

" Er, yes, I am," I smiled, in yet another attempt at competency. "What seems to be the problem?" I risked a glance at the lady sitting up in the bed, clutching her chest.

"Mrs. P has chest pain!" exclaimed the nurse reproachfully, as if berating me for not mind-reading this fact.

"Ah yes, of course she does. Hello Mrs. P. I'm Daisy, one of the doctors. I hear you've got a bit of a sore chest?"

"Ahhhhhhh!" moaned Mrs. P, rocking back and forward, hands clutching her breast.

"Pretty sore, huh?" I said. We ran through a brief history, when somewere around a paternal MI at the age of 63, she began to moan even more. It occurred to me that if I were to capture some ST depression on paper then this might help our management decision. It was with a mixture of dread and fear that I beheld the telltale raised lines on the red and white.

"She's infarcting!" I whispered, to no-one in particular.

"It's OK, Mrs. P," I said, in what I hoped was a calm voice. "I think you're having a heart attack. Now, I'm just going to get you some very strong painkillers, so if you just take this in the meantime (thrusting the GTN spray under her tongue) I'll get that into you." I threw on an oxygen mask (for her, although I was running a fair risk of respiratory alkalosis myself) and with trembling hands, made up the diamorphine, with one eye on the cardiac monitor, murmuring words of encouragement to the moaning Mrs. P as I did so. The Diamorph, as with all emergency medicines, was proving tought to handle and it took me several attemps to suck it up, another 30 seconds to titrate it to the right quantity and another 20 to remove all the air bubbles. Where was Edward?!!!

"Here we go, Mrs. P" I said, inserting the syringe into her venflon (green, phew). "This is a very strong painkiller and you should feel better pretty soon." I injected the first ml.

"How's that?"

"Aaaaaah!" Still no change. One minute later and another ml was liberated.

"How's about that?"

"Oh the pain, the pain!" 5mls of diamorphine later, and she was clutching my arm a little less fiercely and the sensation was beginning to return to my fingers.

"See, I told you," I said brightly, mentally checking off the heart attack list in my head. Oxygen, diamorph, ECG, aspirin, metaclopramide, GTN....metaclopramide! Bugger! I made for the drugs cabinet, but it was too late, as Mrs. P started to gurgle ominously. I swiftly changed course and got in there with the sick bowl just in time. A figure sashayed through the curtains. I looked up and saw Dr. Berkeley, one of the Consultant Physicans above me.

"I'll take it from here, Daisy," he said.

"Oh thanks Dr. Ber...." I started to say, pointing at the half filled syringe of metaclopramide.

"How're you doing?" he said, taking the sick bowl from me and putting an arm around Mrs. P.

"Hrrrrrrrrrrghhh!" went the lady in question, before projectile vomiting another stream of light brown puke across the room.

"That's it," he hushed, reassuringly patting her on the back. "Nice deep breaths. In........out.......in.....out."

"Dr. Berkeley!" I hissed. "She's infarcting! Acutely! And anteriorally!" praying my ECG reading skills were up to scratch.

"That's right!" he said, in measured tones. "And in....and out. You're doing really well!"

They all have their own different ways of dealing with patients. We have 4 different Consultants. Each tends to be quite into their own speciality, something they get around by referring any patient who does not come under this category onto one of the others, and accepting customers in a similar vein. Take Dr. Flett, the Geriatrician, for example. His office is like a shrine to Calcichew and he has the Risedronate Drug Rep. on his Friends and Family list.

The week was livened up by a timely trip into Downtown Drumnadrochit. We sat around a table in one of the pubs, occupying a sizeable proportion of the bar. I found myself sitting next to John. We were planning on staying out all night and heading onto another pub later on. Two hours later, when everyone else had begun to make signs of moving on and was draining the dregs, I noticed that I hadn't said a word to anyone else. Well, unless you count a terse 'Yes," when Poppy, one of the SHOs asked me if I was enjoying my rotation. All things considered, the evening had gone pretty well. I had only embarrassed myself 5 times and spilled one drink.

"I, er, think I'm going to stay here and finish this," I said, avoiding their eyes and trying to look as though I couldn't possibly down 3 mouthfuls of wine. Janey gave me a look as if to say "I know what you're up to!", rolled her eyes and walked on.

"Shall we?" asked John, arching an eyebrow. This was it. Don't mess up Daisy, don't mess up! I slowly got to my feet and we headed to the door.....

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